Outcome of the Direct Admission System for STEMI Patients to the Catheterization Laboratory (D-Cath) within the Bangkok EMS Network
Tanya Pitiyakulchorn, MD¹
, Kanokwan Sukma, BNS¹
, Thanthaporn Hiransasithanon, B.PMD¹
, Petcharat Panyapanuwat, BSc, MSc, PhD²
, Warawut Umpornwirojkit, MD³
Affiliation : ¹ Bangkok Emergency Medical Service Center (Erawan Center), Medical Service Department, Bangkok, Thailand; ² Research and Medical Education Center, Office of Medical Service System Development, Medical Service Department, Bangkok, Thailand; ³ Taksin Hospital, Medical Service Department, Bangkok, Thailand
Objective: To compare treatment timelines, diagnostic concordance, and short-term mortality between ST-elevation myocardial infarction (STEMI) patients transferred via the D-Cath system and those managed without the system.
Materials and Methods: A prospective descriptive cohort study was conducted among STEMI patients diagnosed in the prehospital setting by the Bangkok EMS system. Patients were divided into the D-Cath group (83 patients) and the non-D-Cath group (83 patients). Descriptive and inferential statistics were applied using an intention-to-treat analysis.
Results: Baseline characteristics were similar between groups. The D-Cath group had a significantly shorter diagnosis-to-catheterization laboratory (cath lab) time compared with the non-D-Cath group (30.0 vs. 51.0 minutes, p<0.001). However, the proportion of patients who reached the cath lab within 90 minutes was similar between groups (68.7% vs. 67.5%, p=1.000). When using a stricter benchmark of ≤60 minutes, a significantly higher proportion of patients in the D-Cath group met this target (62.7% vs. 50.6%, p=0.022). The diagnosis-to-wire crossing time was also shorter in the D-Cath group (87.0 vs. 106.0 minutes, p=0.045). While the proportion of patients achieving wire crossing within 120 minutes did not differ significantly between groups (59.0% vs. 50.6%, p=0.125), a significantly higher proportion of patients in the D-Cath group achieved wire crossing within 90 minutes (42.2% vs. 21.7%, p=0.002). Diagnostic concordance between prehospital and in-hospital physicians was 70.5%, and 48-hour mortality did not differ significantly between groups (12.0% vs. 15.7%, p=0.500).
Conclusion: The D-Cath system significantly reduced both diagnosis-to-cath lab and diagnosis-to-wire crossing times. However, the relatively low diagnostic concordance raises concerns regarding the efficiency of resource utilization. Further studies with larger sample sizes are needed to better determine the overall clinical benefit of this system.
Received 11 December 2025 | Revised 21 March 2026 | Accepted 25 March 2026
J Med Assoc Thai 2026;109(10):823-7
Keywords : STEMI; Direct admission; Catheterization laboratory; Bangkok EMS
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